General Disclaimer: If you look at the blog and think to yourself an entry seems unfinished or unorganized...it very well may be. I save while I'm working on it because the power and internet go out so frequently at the house that I lose the work.
It's already Friday afternoon, I guess time flies as fast here as it does back home. It's been a productive week at the office. Yesterday I was able to make contact with some key people at the Malawi Ministry of Health and the World Bank to obtain some health data they have. If they come through it would be bitter sweet because it would save a lot of trouble but then I may miss out on traveling all over the country to collect the data myself. I'm hoping I still get to travel for the data and can find some excuse for it. Nerdy aside: I also used my first excel macro and it worked! I avoided Visual Basic for so many years and of all time now I break down and use it.
I also took a couple pictures of the beautiful home I am staying in with a wonderful family and the two sons:
This is the main house where the family lives. I stay in an attached one bedroom suite. There is also another attached suite in the back for the housekeeper's family (husband, wife, and 5 kids (one of whom is at boarding school). There is a large brick wall surrounding the house with an electric alarmed fence on top. There is one guard during the day, two at night, and staff for cleaning and gardening.
Today I made my first field visit! I visited Kabudula Community Hospital. The purpose of this trip was to see a hospital MaiKhanda is working with in order to see how they collect data so that I can do the same data collection at random non-MaiKhanda hospitals around Malawi. The trip took about an hour from the central office and was not too far distance wise but the conditions of the road once we left pavement made it slow going.
The hospital looked nice on the outside but when you enter you realize what the people of Malawi have to work with. Hospitals are generally very understaffed and under equipped yet this one delivers two to three hundred babies a month, and judging by the record books, an impressive number without complication considering the environment. Although this is a public government hospital, they do not always receive supplies on schedule. For example, today there were no sterile gloves so they made do with other gloves. It's not uncommon for mothers to give birth on the floor when the few beds they have fill up. The ward looked generally dilapidated with windows broken, cabinets in disrepair, and a hodgepodge of random, mismatching furniture and equipment. The staff is impressively resourceful and although they have protocols for situations that arise, many times they cannot follow them correctly due to lack of supplies but they improvise the best they can.
The hospital is built more like a compound where after you walk in the front entrance you walk outside from building to building. I looked at records in the labor and delivery area, maternal ward, and the theatre (OR). All three areas house the records that MaiKhanda is interested in pertaining to maternal and neonatal health.
After visiting the different wards I sat in on a QI meeting that Rodrick led. He had most if not all of the nurses, midwives, and hospital staff present. I wondered how things were running without them in the wards...I was rather impressed with the meeting, there was a clear agenda: today the focus was partograph usage and postpartum hemorrhage reporting and handling. There were charts to show the numbers by month for performance. The meeting ran about an hour and just about everyone there participated and contributed ideas for improvement. Many cited obstacles such as lack of supplies and staff as reasons for not adhering to protocols such as obtaining vitals immediately an regularly after birth. The meeting was productive in that a plan of action was established and a follow up meeting in one week was scheduled. The staff came up with the idea of requiring self-documentation of tasks in order to boost adherence and improve performance. Of course you can think of many things that can go wrong with this idea but I was impressed with their participation and their sincerity and desire to improve. Rodrick skillfully tapped everyone for information and made sure the motivation came from the staff themselves and gently nudged them in the direction of good ideas for improvement. The atmosphere was light and bringing soda and muffins also didn't hurt.
Most of the community hospitals like Kabudula do not have physicians on site. They are run by clinic officers which are somewhat analogous to PAs in America and perform procedures like Caesarian Sections. The staff also includes of nurses/midwives who handle the bulk of labor and delivery. They attend 3 years of school after secondary school for training. The several midwives I spoke to were sincerely dedicated to their work. There is only one medical school in the country and it is very competitive which explains the massive shortage of physicians.
This is the first place I've been where I turn a lot of heads, and not because of my amazing physique and rugged good looks. When I am out around the city and especially in rural areas like today at the hospital, I can feel dozens of pairs of eyes looking at me as I walk around. I wonder what's going on behind those eyes. Malawi's nickname is the Warm Heart of Africa and from my short time so far here it lives up to that reputation. Every person I encounter is very polite and warm in their greetings. In general you see a lot of smiles and heads held up high when walking and driving around. The spirit feels high here and although I may not fit in physically very well, I sure feel welcome and at home.
If you have any questions as I post let me know, I know I'm not being very organized and leaving things out as I try to capture this overwhelming experience.